tbuckley/cabot-search huggingface dataset:
H11 More cancer, better counting or better at diagnosis? The history of skin cancer registration
Authors: Timothy Apthorp, Zoe C Venables, Nick J Levell
Journal: British Journal of Dermatology (2023)

Abstract Cancer registries help us to understand skin cancer cause, prevalence, treatment and prevention. They provide evidence to gain new healthcare resources. This paper studies the evolution of cancer registries and their relevance to dermatology. In the 16th century, ‘Bills of Mortality’, the first English healthcare registry, catalogued the number and causes of death in London parishes. Originally set up to track bubonic plague, it expanded to cover other diseases, including cancer. The 1728 London ‘General Census of Cancer’ was an early systemic study of cancer. In the 19th and early 20th centuries, hospital censuses often monitored cancers. These were superseded by population-based cancer registries, allowing continuous data collection. An early example is the Hamburg Cancer Registry (1926), which recorded names on a card-based registry and compared them with death certificates. The first national cancer registry was the Danish national cancer registry, formed in 1942. In the UK, the Scottish Cancer Registry was formed in 1958, the Welsh Cancer Intelligence &amp; Surveillance Unit in 1972 and the Northern Ireland Cancer Registry in 1994. In England, eight regional registries were created, with the South West being the first in 1945. The Calman–Hine report (1995) highlighted a desire for a national cancer registry. In 2008, the National Cancer Intelligence Network enabled the assimilation and analysis of data sets from English registries. They merged in 2013, forming the National Cancer Registry and Analysis Service (NCRAS), England. Critically, the 2006 National Health Service act (section 251) allowed cancer data collection without formal consent. Although melanoma data were generally good quality, the inclusion and quality of nonmelanoma skin cancers (NMSCs) were historically less reliable, with improvement since 2013. Historically, the exclusion of NMSCs from published cancer data is common. Wales is the last UK registry to not routinely report NMSC. However, this is due to change in 2024. The ‘global burden of disease tool’ (1990) utilizes various sources, including cancer registry data, to model incidence, mortality and health implications of disease globally, including melanoma and NMSCs. In 2022, the British Association of Dermatologists joined with the NCRAS to develop the Get Data Out skin tool, an annually updated website featuring more granular epidemiological data on skin cancers. High-quality epidemiological data are essential to understanding skin cancer’s regional and chronological variations, and to ensure that resources for healthcare and research are allocated appropriately.
BG02 A case of Werner syndrome: undiagnosed progeroid syndrome presenting as female pattern hair loss
Authors: Jennifer Elias, Rakhi Singh-Raghunath
Journal: British Journal of Dermatology (2023)

Abstract A 27-year-old woman of Pakistani heritage with a background of type 2 diabetes, hypertension, hypothyroidism, infertility and Achilles tendinopathy was referred to the dermatology department for diffuse hair loss. She had greying of the scalp hair from the age of 20 years and, on examination, there were signs of hair fragility and thinning. Biopsies showed female pattern hair loss. Topical minoxidil 5% twice daily was advised. At the consultation, it was noted that her facial features included a thin nose with micrognathia. She had dental implants and had undergone cataract surgery at 19 years of age. Scleroderma-like changes were noted on the face and over the distal joints, alongside axillary freckling and excessive lentigines for her age and skin type. She was of short stature and low weight, with a body mass index (BMI) of 15.4 kg m–2. There was thenar and hypothenar wasting and loss of gluteal fat. Her parents were consanguineous (first cousins). One of her brothers, who had similar facial features, died aged 30 years from osteosarcoma. The patient and her partner had undergone two unsuccessful cycles of in vitro fertilization following 5 years of failure to conceive naturally. Medication consisted of atorvastatin, Calcichew, levothyroxine, lisinopril, metformin, pioglitazone and repaglinide. Routine bloods and hormone profile were normal. Despite her age, BMI and statin treatment, blood lipids were raised and a liver ultrasound showed fatty changes. The dermatology department queried Werner syndrome and referral to a tertiary lipodystrophy clinic was made. The lipodystrophy genetic panel was completed. Homozygous null mutation at the WRN locus was found confirming a diagnosis of Werner syndrome. Werner syndrome is an extremely rare autosomal recessive form of progeroid syndrome first described by Otto Werner in 1904. The hallmark sign is the striking disproportion between the patient’s age and appearance. WRN encodes the eponymous WRN protein, a member of the RecQ-like DNA helicase family. The prognosis is unfavourable, with a mean survival of 54 years. Primary causes of mortality are cardiovascular disease and malignancy, with melanoma, thyroid cancer, osteosarcoma and soft tissue sarcoma being the most common forms. There is currently no specific treatment. Management is close multidisciplinary monitoring and treatment of associated conditions. A 2010 study of the Werner syndrome mouse model found vitamin C supplementation to be beneficial (Massip L, Garand C, Paquet ER et al. Vitamin C restores healthy aging in a mouse model for Werner syndrome. FASEB J 2010; 24:158–72). As the condition results in excess damage on ultraviolet exposure and a high risk of melanoma, as well as nonmelanoma skin cancers, an annual dermatology skin check is required.
DE06 Application of the virtual flipped classroom as low-fidelity simulation in dermatology undergraduate education
Authors: Rebecca Golenya, Fiona Campbell, Katharine Warburton, Jonathan Guckian
Journal: British Journal of Dermatology (2023)

Abstract Since the COVID-19 pandemic, the zeitgeist of teaching has evolved with virtual platforms becoming increasingly popular among both learners and institutions. Educators have had to adapt delivery methodologies to this constantly evolving digital landscape. The flipped classroom methodology is a methodology whereby learners receive information prior to the class. This enables learners to process information, increasing time for higher-level learning and problem-solving during session time. A previous scoping review demonstrated that this methodology has rarely been employed in dermatology teaching. We aimed to evaluate integration of a flipped classroom approach within a digital undergraduate setting, specifically assessing the impact on self-directed learning and written skills. Sessions involved the provision of three ready-made dermatology clinical cases, steeped in realism via inclusion of simulated referral letters, recording of patient actor histories and photographs of rashes. Students were instructed to document, request tests and prescribe as if they were a doctor, in their own time, and send requests to the educator. In total, 115 third-year medical students rotated through dermatology and were emailed online evaluation forms. Consent was sought prior to completion of the questionnaire. Sixty-three students responded. Ninety-seven per cent undertook the required prework. Ninety per cent of students felt motivated to undertake the prework, with 87.3% agreeing that the prework was an effective use of their time. Students agreed that their problem-solving skills (90.5%), analytic skills (90.5%), written skills (77.8%), self-directed learning ability (87.3%) and ability to communicate dermatology diagnoses (93.7%) improved. The session was received well by the students, as 94.9% agreed that the session was enjoyable and preferential to lecture-based material (82.5%). Qualitative data included themes of novelty, ability to visualize oneself as a doctor and intrinsic motivation. The flipped classroom methodology is rarely used within dermatology medical student teaching. This methodology was well received by students, and benefits included the development of independent learning and essential written skills. This format of a flipped classroom approach may provide benefits for professional identity formation in the context of digital environments that otherwise seem unrealistic to undergraduates.
CD08 Double bubble trouble
Authors: Mirain Phillips, Anna Davies, Natalie Stone
Journal: British Journal of Dermatology (2023)

Abstract A 29-year-old woman of Lithuanian heritage was referred to dermatology with a 3-year history of recurrent blistering to the hands and, occasionally, feet. The patient’s own photographs revealed small, tense blisters on the sides of her fingers and one on the foot. In the general dermatology clinic, she was noted to have acrylic nails, which she had been applying at home with her own gel nail kit for over 5 years. In recent years, the patient had noticed that use of the acrylic nail kit exacerbated her blistering. There was no prior history of skin disease or atopy. She was otherwise well, with no known allergies. She worked in the food-packing industry where she wore nonlatex gloves. In light of her frequent, prolonged use of acrylic nails and exacerbation of blistering on use of the home kit, she was suspected to have allergic contact dermatitis (ACD) to acrylates and was referred to the patch test clinic. Patch testing was performed to the British standard, facial, rubber and acrylate series. She had positive reactions to five different acrylates, confirming a clinical diagnosis of ACD relevant to her use of acrylic nails and gel polish. However, she was noted to have several unusual features. Clinically, she had small round scars on the dorsum of both hands. On questioning, she described scars occurring after each blister. Blisters occurred all year round but were significantly more frequent in the summer months. Exposure of her gel nails to ultraviolet (UV) light was felt to trigger the blistering. This prompted additional tests to investigate possible photosensitivity. Both urine and plasma porphyrin levels were significantly elevated, confirming cutaneous porphyria. This is an unusual case of a dual pathology causing blistering of the hands: ACD to acrylates and cutaneous porphyria. In most circumstances, it is ACD that is the overlooked diagnosis, but here, an important general medical diagnosis may have been missed. It is important to remember that blistering caused by gel nail kits may be multifactorial, with acrylates causing ACD and UV light possibly triggering cutaneous porphyria.
H17 Traditional medicine: a warts-and-all tale
Authors: Lisa Murphy, Anne-Marie Tobin
Journal: British Journal of Dermatology (2023)

Abstract A viral wart is a common benign lesion caused by infection with human papillomavirus. They typically present in children; however, they are also often seen in adults, particularly in immunosuppressed patients. Modern treatments for viral warts include cryotherapy, cantharone, cautery and curettage, and topical chemotherapeutic agents. However, historically, a variety of methods were employed to treat viral warts: animal-based, plant-based, mineral-based and magicoreligious. These can be further categorized based on the principles of chance and transference (Barron C, Soverino T. Snails, water in a stone, and Holy Wells: an examination of wart cures from the Irish Schools’ Folklore Collection, 1937–38. Folklore 2020; 131:386–412). One popular method that combined both the principles of chance and transference involved finding a snail by chance and then rubbing it on the warts, and skewering the snail to kill it. The concept behind this method was that the warts would be transferred to the snails and then the warts would subsequently decay with them. Another animal-based cure involved stealing a piece of meat, usually bacon, and rubbing the meat into the wart before burying the meat. In terms of mineral-based cures, there were many popular methods. The most commonly encountered treatments included holy water, forge water (often from a blacksmith), water from a stone or ‘wart rocks’. People would also attend ‘wart wells’ and make offerings of stones. The use of water was the most widespread mineral-based cure. Plant-based cures were also prevalent, with the milk of a dandelion, the juice of a potato, rushes and straw being just a few examples. Plant-based cures were often combined with aspects of religion. One cure involved cutting a potato in two, and rubbing the cut part to the wart in the name of the Father, Son and Holy Spirit. The potato was then put away in an old wall; when it shrivelled up, it was believed the wart would disappear. There were also ritualistic methods. Certain healers could perform prayers, and it was believed that when a funeral would pass, one should lift clay three times from under the right foot and rub it on the warts. They would then need to throw it away after the funeral. As the corpse wasted away, the warts would decay, too. While the natural trajectory was that these warts would have self-resolved irrespective of the cures used, our ancestors were proactive and employed many different methods to treat this common ailment.
DE05 Designing and implementing dermatology procedural video education for trainees
Authors: Justin Bui, Sally Aziz, Conn McGrath, Aveen Connolly, Serhiy Aleksyeyenko, Karina Jackson, Lucy Moorhead, Bhaveet Radia, Marcus Samperi, Andrew Pink, Catherine Smith, Alison Sears, Rakesh Patalay, Satveer Mahil
Journal: British Journal of Dermatology (2023)

Abstract Surgical exposure can be varied during specialty training in dermatology. During the COVID-19 pandemic, this was compounded by the reduction in face-to-face teaching, adding a further barrier for trainees trying to access practical skills training. We sought to enable uniform, accessible and inclusive teaching of common biopsy techniques to improve the confidence and proficiency of dermatology trainees in performing these procedures, through a virtual self-directed format. We produced a series of concise educational videos detailing the biopsy consent process and instructional videos on techniques for punch biopsy, shave biopsy, incisional biopsy and simple excisions. Each video was ∼10 min in length with demonstration of the technique on porcine skin in real-time and step-by-step narration. The videos were developed according to up-to-date recommendations of best practice, including those from the British Society of Dermatological Surgery. We used multidisciplinary expert input from Mohs surgeons, specialist nurse practitioners, dermatopathologists, clinicians with expertise in medical education, learning innovation advisors and media experts. We highlighted important learning points for trainees during the videos such as common biopsy indications and complications, practical pitfalls and techniques to enhance biopsy efficiency, diagnostic yield and cosmetic outcome. Our educational videos were launched initially at a large teaching hospital in the UK and watched by 25 dermatology trainees, with plans for upcoming open-access via our education website. The effectiveness of our learning material was evaluated through a preintervention survey of trainees to gauge prior exposure to dermatology surgery, followed by a postintervention survey. We found evidence of a lack of exposure to procedural dermatology among trainees in the preintervention survey, with improvements in trainee confidence reported following the educational videos. Delivering procedural videos through an accessible online resource is beneficial for dermatology trainees and allied healthcare professionals performing biopsies and diversifies the modality of procedural dermatology education. An online video format provides self-directed education that has flexibility and enables repeated access to reinforce learning, which complements and enhances in-person practical teaching.
H07 Papyri and sarcophagi: a tour of dermatology in Ancient Egypt
Authors: Faaris Zaki
Journal: British Journal of Dermatology (2023)

Abstract Long before medicine was demystified by the Renaissance, Enlightenment and modern thinkers with whom we are most familiar, the skin and its diseases were pondered on by the Ancient Egyptians. Through their writings and remains, modern scholars are able to assemble a picture of what dermatological conditions ailed the Egyptians and how they were contemporaneously perceived. The Ebers Papyrus (c. 1550 Bc), the largest record of Ancient Egyptian medicine, is noted for its vivid descriptions of lesions and grisly details of treatments. Some of the conditions mentioned therein are straightforwardly identified from their descriptions, whereas others are open to interpretation. Recent DNA evidence has also shed light on this topic, causing scholars to re-evaluate the presence of various conditions, such as leprosy and tuberculosis, in different parts of the ancient world. The Egyptians are perhaps most famed for the preservation of bodies through the process of mummification, which provides us with a unique glimpse into the nature of skin disease in the ancient world. Mummified skin tends to be shrunken, deeply pigmented and brittle. Even so, nails, hair and epidermal ridging are preserved. Prolonged rehydration and staining can reveal the stratum corneum, keratinocytes, melanin, collagen and elastic fibres, along with adnexal structures and subcutaneous tissue. Mummies with identifiable dermatological disease include Ramses V (d. 1145 Bc), whose face, neck, shoulders, lower abdomen and scrotum bear the marks of smallpox. The diagnosis was later confirmed by electron microscopy, which identified the variola viral corpuscle in his skin. Skin tumours have also been found in mummified remains, as have syndromic features of diseases, which predispose to multiple dermatological malignancies, such as Gorlin–Goltz syndrome, which is suspected in two fraternal mummies from around 3000 Bc. One specimen from c. 1300 Bc was identified as having a venous ulcer, which was subsequently confirmed when histology demonstrated perivascular haemosiderin deposition. Other tentative diagnoses have been made on appearance alone, including pustular dermatosis, impetigo and pemphigus foliaceus. Too often do we perceive medical history as starting in earnest during the last few centuries. The Ancient Egyptians have bequeathed to us a wealth of information, both historical and archaeological, which, combined with modern techniques, has allowed us to peer through the millennia into a dermatological world that can feel simultaneously alien and familiar. This presentation/poster will showcase what we understand of this world and what future research might hold in store.
BI18 The role of an acute on-call dermatology service in a haemato-oncology unit using pioneering treatments: a retrospective analysis of 134 dermatology consultations in a tertiary hospital
Authors: Rhiannon Nancarrow-Lei, Emily Durity, Yasmin Alfallouji, Claire Martyn-Simmons, Evangelia Panagou
Journal: British Journal of Dermatology (2023)

Abstract Our dermatology department receives the largest number of internal on-call referrals from the haematology–oncology department. Patients with haematological malignancies are particularly vulnerable to an array of dermatological conditions due to immunosuppression and multiagent exposure, which can impact cancer treatment and result in significant morbidity and even mortality. Our primary objective was to quantify and analyse the dermatological conditions encountered. Our secondary objective was to identify potential associations of dermatological conditions with haematological malignancy subtype and anticancer therapies. We conducted a retrospective single-centre review of acute haematology–oncology referrals to an on-call dermatology service made between August 2020 and November 2022. Consultations were retrospectively identified from the dermatology on-call referral log. In total, 134 patients were identified. Underlying haematological malignancies were categorized into lymphoid neoplasms (45%), myeloid neoplasms (29%), plasma cell dyscrasias (13%), Hodgkin lymphoma (6%) and other (7%), with acute myeloid leukaemia (AML; 20%) being the most frequently seen distinct haematological malignancy. Cutaneous adverse drug eruptions (23%), infections (13%), folliculitis/acneiform eruptions (10%) and eczematous dermatoses (7%) accounted for the most common diagnoses, followed by benign skin lesions (6%), cutaneous lymphoma (6%), leukaemia cutis (5%) and cutaneous vasculitis (4%). Notably, cutaneous drug reactions frequently occurred in patients with myeloid neoplasms (32%) and, out of all malignancies, most frequently in multiple myeloma (26%). Folliculitis and acneiform eruptions occurred predominantly in patients with myeloid lineage malignancy (i.e. AML and myelodysplastic syndrome; 73%), although it is unclear whether they were triggered by the underlying malignancy or treatment received. Fifteen patients (11.2%) undergoing novel chimeric antigen receptor (CAR) T-cell therapy were referred to our on-call dermatology service. In conclusion, dermatology plays an integral consultative service to patients from haematology–oncology. Skin biopsy is diagnostically useful and has been crucial in the early detection of lymphoma and leukaemia recurrence. However, with the recent development of new CAR T-cell therapies and other novel agents, new adverse dermatological complications are surfacing, and this is likely to increase the demand for dermatology input.
GD06 The grass is always greener on the nearer side
Authors: Lisa Murphy, Anne-Marie Tobin
Journal: British Journal of Dermatology (2023)

Abstract Climate change is becoming a significant matter of concern, and ways to reduce our impact on the environment are becoming an increasing priority. We assessed the difference in carbon emissions when patients attended our peripheral dermatology clinic rather than the tertiary centre. Our objective was to establish the reduction in carbon emissions when patients attended satellite clinics instead of a tertiary service. The addresses of patients attending clinics over a month-long period were compiled, and distances to both hospitals were measured. These were compared, and the difference was used to calculate the reduction in carbon emissions. The emissions produced by staff members were added to the total of emissions produced by patients travelling to peripheral clinics. In total, 245 patients were included in the study. The total distance travelled by patients for a round trip to the satellite clinic was 10 105.9 km, and the equivalent for the tertiary centre was 14 775 km. The mean distance travelled by patients to and from the peripheral clinic was 41.25 km. The mean distance travelled by patients to and from the tertiary hospital was 84.69 km. The amount of carbon emissions produced by the patients travelling to the peripheral hospital was 1.87 tonnes. The amount of carbon emissions of patients travelling to the tertiary hospital was 2.73 tonnes. This was a saving of 0.86 tonnes over a 1-month period. Annually, this amounts to a difference of 10.32 tonnes of carbon emissions. The provision of peripheral dermatology clinics has a significant positive impact on the environment and greatly reduces the distances travelled by patients. Our study suggests that satellite clinics could reduce carbon emissions by 10.32 tonnes annually. This equates to 138 flights from Dublin to London, or 12 900 takeaway coffees. This study has demonstrated that the provision of peripheral clinics can make healthcare more sustainable, by reducing the number of carbon emissions being produced.